Your article is so informative, Paula. Baby boomers really do need
tax breaks when they become caregivers for their parents. Especially
women....it is so true, they really are more likely to leave a job or
cut back their hours so they can take care of their parents.

I just can't see legislation to compensate caregivers -- or even give them
tax credits or deductions -- in this political climate, can you? We can
argue in vain that Medicaid is saving a bundle every time a family keeps an
older person out of a nursing home, but I still can't see it.
The people in the study were taking care of grandchildren too, or in some
cases spouses, not just parents.

Oh, definitely not in this climate. That's for sure.
I know a 42-year-old who went on Medicaid last year because of her
multiple sclerosis. Her mother is taking care of her, and her sisters
help when they can.
Her mother retired much earlier than she really needed to in order to
take care of her.

Several states piloted programs called Cash & Counseling a few years back --
California was one of them -- in which Medicaid recipients who needed home
care could choose whom to hire, rather than just accept whoever the agency
decided to send. Often, they chose family members, so those family
caregivers got paid modest wages. It seemed to work very well but it does
not appear to have expanded.
So families still are expected to take on eldercare -- and they do take it
on -- but in the process they frequently have to leave the workforce or cut
back on participation. And they pay the consequences down the road.
75 comments on the blog so far, and several from women detailing how they
left jobs or segued to part-time work and never returned to full time,
because they had parents or spouses who needed their care. Now they have no
savings, very low Social Security payments, and they are basically screwed.

At my 30th high school reunion there were at least a dozen of my
classmates who are currently the sole caregivers to aging parents. Most
are women. Several do not work outside the home. The rest are trying
to juggle full time work with full time caregiving. It is not a good
system.

It hardly even deserves to be called a "system," which implies a certain
logic.
And it is ultimately unsustainable in a world where both men and women want
and need to work.
By the way, though both immigrants and certain stripes of conservatives are
quick to blast Americans for "abandoning" their elders -- because we
selfishly move away from home, because we're too careerist, because we're
feminists, because we're too *something*. But this same crisis is happening
in many other countries, including China, where filial duty is about as
culturally pronounced as anywhere in the world. But once societies
industrialize, once women enter the workplace, once people move away from
their villages to where the jobs are -- suddenly there is nobody at home to
care for the parents, whatever country you're in. China is building nursing
homes at an astonishing pace.
Lisa, at your 40th reunion, the number of people (mostly women) caring for
their parents will be higher still.

I think we see a lot of that here in Pittsburgh. It's a cheap enough
place to live that a couple in their 40s or 50s can live on one salary
while the other is a part-time caregiver for parents and older relatives.

Thank you for this rich discussion. I have a hypothesis about "A Very
Ungrateful Old Lady"; Im curious about your thoughts. Clues to the
roots of Mrs Klass's behavior are embedded in paragraph 3, in which she
writes, My own parents, working class Orthodox Jews in Brooklyn, were
ordinary people trying hard, but beset by the Depression and bad
luck. Which means the young Sheila Solomon Klass was immersed in a
superstitious subculture grappling with the Holocaust.
Back then, working-class Jews in NYC were baited, beaten and berated
by local working-class Irish, Italians, and Germans. Working-class Jews
took on tougher, meaner ways of interacting with the world,
maintaining stoic independence, because ignorant working-class
Americans considered Jews to be weak and ineffectual for getting
trapped and killed by Nazis. As late as the 50s and 60s, 1st-gen
Orthodox Jewish Americans in Brooklyn, such as my father, used American
names in public to avoid harassment. (His given name, Shlomo; his
business card identified him as Steve).
Many American Jews with European relatives and friends who disappeared
during the 30s-40s devoted precious resources to search for
Holocaust survivors, and bring them to the U.S., where they had to be
cared for. Among working-class Orthodox Jews in Brooklyn (my heritage),
families donated money to help locate and transport survivors, so
money spent to stitch up Mrs Klasss knee MIGHT otherwise have gone to
what the adults considered a higher purpose, conveyed or implied.
Additionally, NOT being a burden was a way to gain respect and
approval from our Yiddish-speaking elders, even as late as the 50s and
60s.
The long reach of the Holocaust and its impact on the behavior of the
survivors and their families cannot be avoided when elderly Jewish
Americans are coming to grips with their life path. In many subtle ways
the Holocaust experience affects how they want to be known and
recalled. The story of Mrs Klass not wanting to be a burden is, I
believe, is linked to her Jewish-American heritage and the Orthodox
culture in which she was raised.
Happy Chanukah, fellow WELL-beings!

inkwell.vue.470
:
Paula Span's New Old Age Blog for the NY Times: Let's discuss!permalink #88
of 99:
David Gans(tnf)Wed 27 Nov 13 12:32

Very interesting post, Linda. Thank you.
(We just saw a wonderful play at the Berkeley Rep, "The Pianist of Willesden
Lane," about a young woman who went to England in the Kindertransport and
became a concert pianist. The story was written and is performed by her
daughter, also an accomplished pianist. It's been extended into January.)

Hi Linda! Yes, I think you can't discount the huge cultural impact of both
the depression, the displacement of immigration and the Holocaust on that
generation of elderly Jews. Plus, isn't there a fair amount of evidence
about the psychological impact of the Holocaust on their children?
But so many older people of various ethnicities hold similar values,
similarly resist help or the suggestion that they might need it, practice
stoicism (or as their exasperated children might put it, stubbornness) that
I think it's a broader phenomenon. This is part of that generation and its
culture, and you can be non-Jewish and have the same fears and values as Ms.
Klass.

ah that's a tremedously sad post. Also a little confusing, though. I agree
with your point in the blog about the bar being set pretty low for verbal
mistreatment.
I'm also unclear about the impact of the mistreatment, though. You wrote
that the study shows "The group that said a caregiver had yelled, sworn or
threatened at least once in the past year had significantly lower social
functioning and poorer mental health than the group reporting no verbal
mistreatment."
But are they clear on whether that's correlation or causation? if anything
the causation to me seems just as likely to go in the opposite direction --
caring for someone with lower social functioning and poor mental health
would be great deal more trying than caring for someone who is doing better
on those measures.

Yes, true, this is one of those correlation-is-not-causation studies. But
note that people with dementia and people who couldn't get themselves to a
university health care center in New York were excluded. So ambulatory and
cognitively intact. And a lot of other studies have shown the same
association.

And what do we do about the question of when to intervene in
situations where words are weapons?
Seems as though after a few decades of heightened sensitivity of how
bigotry is enforced -- often mocked as "political correctness" -- there
is even less broad agreement on which words and insults are just not
acceptable. Add in generational and cultural variations, and perhaps
it becomes the emotional intention, not the language, that wounds.
Plus, some people joke effectively with family members without anybody
feeing hurt, while others "joke" some of the time and stray over into
cruelty now and then. Very hard to sort out interactions like that,
when power relationships have flipped, and perhaps there were old
wounds on the other side in the past, and some rough joking at a
child's expense.
After childhood, it's pretty much up to the victim of abuse to
determine if the use of language is abusive, and that often seems
bizarre to the one doing the name calling or swearing.
Tough calls for unrelated observers. Even worse if it's your sibling
and your parent in the interaction. How do you decide to intervene?
And what do you do then?

(just realized it sounds like I was saying Paula's blog post was confusing,
which it wasn't at all! it was the study that confused me a bit)
> a lot of other studies have shown the same
association.
I would still wonder in which direction the causation was happening, if it
was causation--my first impulse, not having seen the data of course, would
be to read it the other way around. But I guess I'd need to know more
about what they meant by "lower social functioning and poorer mental
health."
And I should hastily add that I am sure verbal/emotional abuse of elders
by caregivers is all too horribly common, and has terrible effects. I'm
just not quite understanding this study I guess.

inkwell.vue.470
:
Paula Span's New Old Age Blog for the NY Times: Let's discuss!permalink #96
of 99:
lies straight from the Pit of Hell(crow)Tue 3 Dec 13 15:32

I have a hard time not getting exasperated with my mom and (sometimes)
letting it show. I know it's not her fault but it's so irritating when she
doesn't understand me or is vague or (occasionally) passive aggressive.
Anyway, I occasionally snap at her.

That's one of the problems, to my mind, with setting the bar for "verbal
mistreatment" so low. If a senior responded that someone had yelled at her
or called her a name once in a year, she was put in the mistreated category.
Lots of excellent caregivers with a human tendency towards exasperation
would suddenly be classified with people who have a real pattern of saying
belittling, insulting, even sadistic things.
It frankly made me a bit uneasy, but I went with the post as a way to raise
the issue.
Gail's question is central, and terribly difficult to answer. In some
families, referring to someone as "you idiot" is standard, unobjectionable.
Others might find it hurtful.
I think one reasonable response, though, is to have interventions available
(like respite care, support groups, other programs under development) to
caregivers who can see that they're starting to lose it, to get snarly under
the pressure. Educate people that name-calling and threats can have real
consequences (yeah, I know, not causation...) and give them a way to get
help when they feel themselves sliding into that zone.

We'd like to thank Paula for participating in this topic.
I can't say enough how valuable the elder.pri conference here on the Well
is. If you are dealing with these issues and want support, you should join.
Meanwhile, you can continue following the New Old Age Blog:
<http://newoldage.blogs.nytimes.com/>
and you can follow Paula on twitter:
@paula_span
and you can find out more about her book "When The Time Comes":
<http://www.paulaspan.com/>
Thanks for participating, Paula!